Provider Demographics
NPI:1457388266
Name:BAKER, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:R
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:409 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7329
Mailing Address - Country:US
Mailing Address - Phone:870-793-5356
Mailing Address - Fax:870-793-7017
Practice Address - Street 1:409 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7329
Practice Address - Country:US
Practice Address - Phone:870-793-5356
Practice Address - Fax:870-793-7017
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC-5033OtherLISCENSE
AR102554001Medicaid
AR50226Medicare ID - Type Unspecified
AR102554001Medicaid